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General NPI Number Information
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NPI Number | 1871907600
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Entity Type | Individual
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Provider Name | AMY ALEXANDRA MARTINEZ
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Gender | Female
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Dates
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Enumeration Date | 06/19/2014
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 13496 ASTORIA ST
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City | SYLMAR
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State | CA
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Zip | 91342-2402
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Country | US
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Telephone | 818-568-8374
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Fax |
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Provider Business Mailing Address
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Address Line | 622 E PROVIDENCIA AVE APT J
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City | BURBANK
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State | CA
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Zip | 91501-2942
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Country | US
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Telephone | 818-568-8374
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 109044
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License Number State | CA
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